“ Knowing your hormonal history increases the chances that the treatment [ your doctors ] choose will be a success.”
This has been the case for Landau, who began working with Dr. Broner five years ago to identify her migraine triggers and create a custom treatment plan, which now includes preventive medication around her period and not combining other migraine triggers during her most vulnerable days.
“ It has changed my life,” Landau says.“ I still get [ menstrual migraines ], but they are a lot less intense now that I have the right combination of medications.”
Treatment options
Unfortunately, no one treatment method meets the needs of every sufferer or every headache, and the obvious solutions aren’ t always effective, Dr. Brandes says.
“ The temptation with menstrual migraines is to want to simplify management of the hormonal influence,” she says.
That might mean going on continuous birth control pills to prevent periods, or using an estrogen patch or other hormone therapies to blunt the hormonal fluctuation.
But such treatments don’ t work for everyone, according to Dr. Brandes. Many women who are on the pill suffer breakthrough bleeding or continuous bleeding that is triggered by hormone fluctuations, and this can lead to more migraines. Other women are not good candidates for estrogen replacement therapy due to a high risk for cancer or cardiovascular disease.
Instead of assuming a one-size-fits-all approach, doctors must work collaboratively with patients to understand their health risks and headache history. Once this record is established, they can try different combinations of medications and track the results.
“ The often-missed hormonal influence on migraine is why it is so important to keep a headache and menstrual diary and for doctors to take a headache history that includes the hormonal influence,” Dr. Brandes says.
For women who suffer from menstrual migraines, that history should include when the migraines start in relation to their first period, when during the month the migraines most frequently occur in relation to ovulation and menstruation, and whether the headaches get better or worse as a result of using birth control pills or getting pregnant.
“ If I know that the oral contraceptive pills made your migraines worse in your 20s, I would be more reluctant to prescribe them as a solution in your 40s,” Dr. Brandes says.“ Knowing your hormonal history increases the chances that the treatment we choose will be a success.” HW
“ Knowing your hormonal history increases the chances that the treatment [ your doctors ] choose will be a success.”
Pop Quiz
How likely are you to get migraines before, during or immediately after your period?
Somewhat more likely – 1 vote
Less likely – 1 vote
Much more likely – 42 votes
Source: NHF Facebook and online survey
No more likely – 4 votes
I never get menstrual migraines – 2 votes
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